An insight into Migraines, more than a headache

Pain is a general word to describe any unpleasant, uncomfortable sensation in the body. Pain can be experienced by one as dull aching, or sharp throbbing. Pain is always annoying but, in some cases, it can be a debilitating experience. Pain can be either continuous or intermittently appearing in nature which may be sudden or gradual in onset. Different people respond differently to pain due to a difference in threshold level in each individual. Some people have a high threshold level where they can tolerate pain while some have a very low threshold level. This is why pain is highly subjective.

Headache is a pain in the head region. The pain may be localized or radiating. Headache may be localized above the eyes, ears, behind the head, and back of the upper neck. Headache has various reasons like other medical conditions. There are about 90 types of headaches.

Headaches can be divided into primary headaches or secondary headaches. Primary headaches are migraine, tension headaches, and cluster headaches. Primary headaches have no other association with any other diseases. Whereas secondary headaches are caused by other diseases. Secondary headache may result from various conditions that range from a life-threatening disease like a brain tumor, strokes, meningitis, brain hemorrhages and from less serious conditions like withdrawal from caffeine effects, alcohol effects or dropping of analgesics effect of pain killer tablets. Mixed headache are suffered by some, where tension headache or secondary headache may trigger a migraine.

Half to three-quarters of adults aged 18–65 years in the world suffers/suffered from headache in each year and, among those people, about 30% have reported migraine. Statistics show 37 million people in the US have migraines or headaches at some point in a year. About 1.7–4% of the world’s adult population gets affected by headaches on 15 or more days every month. Headache is a worldwide problem despite regional variations, ages, races, income levels, and geographical areas.

Migraine headaches are the second most common type of primary headache. Migraine is a neurological condition. Migraine is characterized by intense, debilitating headaches that have severe throbbing pain or a pulsing sensation, usually on one side of the head, and exposure to bright to light and loud sound makes the patient hurt. Migraine causes many symptoms such as nausea, vomiting, difficulty speaking, numbness or tingling, and sensitivity to light and sound. Migraines affect people of all ages and they often run in families. In children, both boys and girls are affected equally by migraine headaches, but in adults, migraine affects more women than men. Most of the time migraines remain undiagnosed or misdiagnosed as tension or sinus headaches. Migraine attacks can last for hours to days. Migraine affects a person’s personality and mental health. Migraine can be so severe that it interferes with your daily activities and reduce your work efficiency.

Treatment of migraine does not give you 100% results. There is no actual cure for migraines. But some drugs can reduce these headaches. So one must be aware of the causes and reasons for migraines.

What are the causes of migraines?

The exact reason that causes migraine is still unknown but it is related to the changes that happen in the brain. Genetics plays an important role in migraine. Earlier scientists thought migraine happens due to change in blood flow in the brain. Most of them now think a change in blood flow can contribute to pain but not the primary cause of migraine.

Currently, scientists think migraine starts due to overactive nerve cells send out signals that trigger your trigeminal nerve. The trigeminal nerve gives sensation to your head and face. Your body releases chemicals such as serotonin and calcitonin gene-related peptide (CGRP). CGRP swells blood vessels in the lining of your brain. Neurotransmitters that are released cause inflammation and pain.

There are various risk factors for migraine. Women get affected by migraines about three times more than males. Most people who get affected by migraines are in the age range of 10 and 40 years. Many women report migraine withdraws after the age of 50 years. Migraine was noted to be genetically transferred to the descendants. Four out of five people with migraines give a history of family members who suffer from migraines. If one parent has a history of migraines, their child has a 50% risk of getting a migraine. If both parents have a migraine, the risk of getting a migraine is 75%. Other medical conditions such as depression, anxiety, sleep disorders, epilepsy, and bipolar disorder can be a factor for migraine.

Common triggering factors that initiate migraine are hormonal changes, stress, food, caffeine, change in weather, medications, and changes in sleep. Many women experience headaches during their periods, during pregnancy, or when they’re ovulating. A drop in estrogen level too can trigger migraine as estrogens do control chemicals in the brain that causes pain sensation. When you are stressed, your brain will release chemicals like cortisol that causes constriction of the blood vessel. This may lead to migraines. Some people report certain kind of foods that contains cheese, alcohol, food addictive such as nitrates (in hot dogs, pepperoni) and monosodium glutamate (Ajinomoto) can lead to migraine. Skipping meals can trigger a migraine. Too much use of caffeine or not getting as much you used to have can trigger a migraine. So caffeine is used as a treatment option to treat migraines. Weather changes to affect. Reports of migraine were noted in people who exposed themselves to a storm, strong wind, change in altitude, and changes in barometric pressure. Loud noise, strong smell, bright light, can trigger a migraine. Some vasodilator medicines, oral contraceptives, hormone replacement therapy, opioid drugs can trigger a migraine. Physical activity such as sex and exercise can trigger a migraine. Changes in your sleep routine that are too much sleep or too little sleep can trigger a migraine. Habits such as smoking and alcohol too trigger a migraine.

What does a migraine tell about your health?

Researches have shown migraine is linked to several medical conditions. Migraine can be a symptom/cause of many medical conditions such as stroke, heart disease, high blood pressure, seizures, hearing problems, posttraumatic stress disorder, depression and anxiety, and fibromyalgia.

There is little evidence that a migraine can trigger a stroke, or that both can happen at the same time. The risk of stroke is higher in some people who have migraines, as in the women population, people under the age of 45 years. Men with episodes of migraines are at greater risk of having a heart attack and heart disease. Women with migraines too have a higher chance of heart disease. The frequency of your migraines doesn’t change your chances of having these conditions.

There is evidence that hypertension may make symptoms of migraine.

If you get migraines, you are at risk of getting seizures twice as compared with people who don’t have a migraine. Reports are suggesting that there may be a genetic link between the two. Researchers believe seizures may have the same genetic cause as migraines.

Migraines increase the risk of sudden hearing loss. This is rare and unusual and remains unexplained, the rapid loss of hearing that happens over a few days. People who get those severe form of headaches get sudden hearing loss twice as often as people who don’t get migraines.

Fibromyalgia causes prolonged pain, fatigue, and other symptoms. Migraines are a common symptom in people with fibromyalgia. Still, no evidence proves the link between fibromyalgia and migraine
Migraines are common in people who have anxiety. If you have both migraines and anxiety, you’re also more likely to have depression.

If you have migraines, you may be likely to have posttraumatic stress disorder (PTSD). A study has found the link to having PTSD is 5 times more if you have migraines.

Few studies suggest that women who have a history of migraines when to get pregnant are slightly more likely to have problems like low birth weight, pre-term birth, and preeclampsia (a condition where high blood pressure and fluid retention). Symptoms of migraine can worsen with pregnancy. So it may require a different treatment approach. Doctors suggest women who have a history of migraines should take advice from a headache specialist before they get pregnant.

Insomnia is reported in people who are suffering from migraines. This in turn increases anxiety and depression which itself can switch on migraine. Poor sleep hygiene can be a major triggering factor for migraine.

Migraine is seen in people who have irritable bowel syndrome, like belly pain, diarrhea, and constipation

Can a migraine be treated?

If you have regular episodes of migraine or if migraine runs in your family you should take treatment suggestions from a doctor who is an expert in treating headaches. A neurologist will be able to diagnose migraine with a thorough medical history, physical examination, neurological examination, and can treat it properly.

If you have a complex, severe unusual pattern of migraine then you need to take an MRI scan Or CT scan to diagnose. MRI scans help the doctor to get a much clearer picture of your brain and blood vessel. MRI scans help doctors diagnose tumors, strokes, brain, infections, and other brain and nervous system (neurological) conditions. Whereas a CT scan uses a series of X-rays that give detailed images of the brain. CT scan helps doctors to diagnose tumors, infections, brain damage, hemorrhage, and other medical problems that may be causing headaches.

Migraine can be treated using two types of drugs. That is abortive and preventive drugs. Abortive drug treatment helps to stop a migraine once it starts or if you feel you are going to have an episode of migraine. Abortive medications can be taken by injection, orally, skin patch, or nasal spray. These forms of medication are mostly indicated for people who have nausea or vomiting related to their migraines. The abortive drug gives fast results. Abortive drugs include triptans and ditans which target serotonin.

Pain relievers such as over-the-counter include aspirin or ibuprofen. Migraine relief medications that combine caffeine, aspirin, and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild migraine pain.

Triptans are prescription drugs such as sumatriptan and rizatriptan are prescription drugs used for migraine. These work by blocking the pain pathways in the brain. Dihydroergotamines are nasal spray or injection. These drugs are most effective when taken shortly after the start of migraine symptoms for migraines. Dihydroergotamines are contraindicated high blood pressure, or kidney or liver disease should avoid dihydroergotamine.

Lasmiditan is an oral tablet used for the treatment of migraine. Lasmiditan helps to relieve pain, nausea, and sensitivity to light and sound. Ubrogepant is an oral tablet used to treat acute migraine in adults. Ubrogepant is effective in relieving pain and other migraine symptoms such as nausea and sensitivity to light and sound. Ubrogepant works within two hours after taking it. Opioid medications that contain codeine found to be effective in treating migraines. Anti-nausea drugs can help to control nausea and vomiting during the episodes of migraine. Anti-nausea drugs include chlorpromazine, metoclopramide, or prochlorperazine. This drug has to be taken with pain-relieving drugs.

Preventive medications are drugs given to prevent frequent migraines. Preventive medication indicated infrequent, long-lasting headaches. It works by reducing the frequency of attacks.

Medications that are used to lower the blood pressure such as propranolol, metoprolol tartrate, calcium channel blockers such as verapamil are used for preventing migraines. Antidepressants such as tricyclic antidepressants (amitriptyline) are effective in preventing migraines. Antidepressants other than amitriptyline are prescribed currently due to their side-effects of sleepiness and weight gain. Anti-seizure drugs such as valproate and topiramate might help you to reduce the frequency of migraines, but these drugs can cause side effects such as dizziness, weight changes, and nausea. Botox injections such as the onabotulinumtoxinA (Botox) when taken every 12 weeks help prevent migraines in some adults. Calcitonin gene-related peptide (CGRP) monoclonal antibodies Erenumab-Aooe (Aimovig), fremanezumab-vfrm (Ajovy) and galcanezumab-gnlm (Emgality) are newer drugs to treat migraines. They are given monthly injections. The most common side effect is a reaction at the injection site such as thrombophlebitis.